We are in Santa Monica, California, on the beach. The
wind is coming from the ocean and the air is clear. It must be a work day
-- there are more birds than people.

I have come to Santa Monica, and to this beach, to think
about Hildred Schuell, the woman who discovered that most cases of aphasia
are curable. Hildred died years ago, but my friend Christine Harris-Sloan
worked with her, and I have been studying Hildred's writings with Christine's
guidance. She is very kind and very intelligent, but after reading everything
she has and badgering her with questions for weeks I find that she cannot
really answer my deepest question, and that maybe no one can. She and a
few others know what to do to help an aphasic client heal, and they know
that it works, but no one seems to really understand why it works.
Or maybe what I want to know becomes obvious when one uses Hildred's therapy
with aphasic patients, and the problem is my lack of experience.

Aphasia is defined as a loss of all or part of ones ability
to use language, caused by damage to certain areas of the brain. It was
aphasia that led to the discovery that the two sides of the human brain
have different functions; the first forty or so cases reported all had
left-side damage. The classical theories held that there were several kinds
of aphasia, affecting speaking, understanding speech, writing, and reading.
The accepted doctrine was that people with damage limited to a certain
area might have trouble speaking but no trouble understanding, while patients
with damage to another area might be very articulate but have trouble understanding
spoken or written language.

The conventional wisdom was that speech and language therapy
were basically useless with these patients -- typically there would be
a period of spontaneous recovery, which would happen with or without therapy
as some of the tissue healed, and after that no therapy of any sort would
restore whatever functions had failed to recover spontaneously. The only
realistic goals for therapy were to teach compensatory coping strategies
and to provide emotional support.

My mentor at the University of Minnesota, Professor James
J. Jenkins, had worked with Hildred Schuell for years and published several
papers and a book with her. One day, as we were driving over to the V.A.
Hospital where Jim was to introduce us, he said something I knew I
would never forget: "All the hot-shot neurologists think Hildred's theories
are crap -- but she's the only aphasiologist in the world that can cure
a patient."

It took a while for that to really sink in; first to be
sure he was serious -- he was. He had said precisely what he meant. Second,
to understand that he was correct. To the best of my understanding, after
all these years of passionate interest and study, he was -- she knew how
to cure aphasic patients and how to teach other people how to cure them.
She even knew how to tell which patients could not be cured. Sadly, however,
she died a few weeks after we met, and I never got to work with her directly.

I did get to work with her student Christine Harris (now
Christine Sloan) and of course with Jim Jenkins. What follows is a summary
of what I learned from them, and from Hildred's writings.

Working with Jim Jenkins, Hildred found excellent evidence
that most aphasics have about the same level of impairment in all four
language modalities -- reading, writing, speaking, and understanding speech,
unless the fundamental sensory or motor abilities were also impaired on
tasks that have nothing to do with language.

For example, a patient's family might report that he could
hear and understand speech perfectly well, but could hardly speak at all.
The family physician had confirmed the diagnosis, as had a neurologist
to whom the case was referred. What Hildred found, with her careful testing
-- using recorded speech to ask questions that could only be answered if
the person really could understand the speech, with no help from situational
cues and nonverbal gestures -- was that the patient's ability to understand
speech was just as badly impaired as their ability to speak. The exceptions
were all patients with sensory or motor impairments, as revealed by tasks
like identifying common sounds -- like water dripping -- by pointing to
a picture of a faucet. On the other hand, somebody who cannot use their
tongue to lick their lips may also have trouble using their tongue for
speaking, but that is not a language impairment, it is a motor impairment
affecting any task that requires coordinated gestures with the tongue.

Hildred also proved that nearly all aphasic patients,
except those in one diagnostic category, can gradually improve if given
the right kind of help. "The right kind of help" has two main characteristics:

First, the patient and the therapist or helper must agree
on and practice one basic rule: The patient is not allowed to struggle.
The entry fee for playing this particular therapy game is to relax. Whenever
the patient begins to struggle, to panic, to try to force the words out
-- stop. Let's both relax, and whenever we are both ready, we can start
again if we want to. This relaxed play is the absolute inviolable condition
of this healing process. Succeeding at the task is never to be allowed
to become more important than succeeding at relaxing.

Second, in the space thus created, protected from any
sort of coercion by either partner directed at either the other partner
or them self, the game is played with no possibility of failure. One of
Hildred's students recounts an incident that must have occurred hundreds
of times over the years as new therapists were trained -- the student has
reported that her patient can't do the currently assigned task. Hildred
responds: "That's very interesting -- how did you discover that?" "We tried
it at least thirty times and he just can't do it." "That's O.K. Try it
a hundred and twenty times.

Failure is impossible, but not because the patient will
eventually succeed at whatever task is assigned. Therapists certainly will
sometimes choose a task that is too advanced, too far beyond the client's
current level of skill. Failure is impossible by executive decree -- because
Hildred said so. Eventually the trainees learn, from their own direct experience,
that sooner or later the therapist will succeed in coming up with the right
exercise, and then the client will eventually produce the right articulatory
gestures.

That is really all there is to it, for most patients,
except for a few details, details such as the fact that no insurance plan
in existence will pay for years of daily therapy sessions at $50 to $100
each. (That is why the method had to be developed by somebody working in
a V.A. hospital, one of the finest in the country.) For people who do not
have access to such resources, an alternative plan had to be developed
wherein the sessions that the patient can afford are done with a family
member of friend or volunteer present, someone who can learn the technique
and then continue to work with the patient with occasional guidance from
the therapist, long after the money has been used up.

The patients who will never recover are those with the
cluster of symptoms that Hildred called "global aphasia." She distinguished
two types of speech, "reactive" and "intentional." Reactive language is
produced in reaction to someone else's utterance, in words dictated by
a habitual formula -- for example, "fine," in response to "How are you?"
Intentional language is generated to accomplish some purpose of the speaker.
Global aphasics have no intentional language. When such patients are given
language therapy with the method described above, their reactive language
may improve -- they might, for example, progress from "fine" to "Fine thank
you, how are you?" However, they will never regain any intentional language
at all. It may be that someday a mode of therapy that works for them will
be developed, but Hildred's definitely does not.

All in all, we are left with two mysteries: First, why
does Hildred's method of therapy work? Second, given that it does work,
why does it fail to work with the global aphasics? That's where I was that
day on the beach -- certain that those were the key questions and equally
certain that I had no way to proceed further in the effort to answer them.
I had already read everything there was to read about Hildred's work, and
discussed it over and over again with Christine, and it wasn't enough.
So I gave up -- gave up the mental effort and started enjoying the sand
and the ocean.

The sand sloped up from the water, up to a low ridge,
then down several feet and then up again, forming a shallow basin behind
the front ridge. A storm had come in at high tide and left ponds of stagnant
water stranded in the basin, all along the beach.

A work crew had brought in a small bulldozer and cut a
trench through the ridge from the pond to the sea. They had then dug with
a shovel a much narrower trench in the middle of the buldozer-wide trench.
Only a narrow dam of sand was left blocking the narrow trench when they
went to lunch.

Most children like to play with water and sand, and I
am no exception -- I'm just older than a lot of the other children. With
my finger I absent-mindedly traced a narrow track through the small sand
dam blocking the shovel-wide trench. A tiny trickle started flowing toward
the sea.

I must have been daydreaming about aphasia again, for
when I next noticed the trenches I was shocked to see that the flow had
become much stronger. The trickle had slowly washed away the sides of my
finger-width grove, which had become nearly as wide as the shovel-wide
trench, and was now about two inches deep. As I watched, entranced, the
flow continued to widen and deepen, until it filled the bulldozer trench
and was over a foot deep! The more it flowed, the wider and deeper it got.
The stagnant water flowed swiftly into the ocean, free once more.

Then I nearly fainted. Hildred's therapy! Protect what
ever flow of communication has survived, and it will gradually increase,
just by being allowed to flow. And if none has survived, there is no flow
to protect, no trickle of communication at all, and no possibility of recovery.

I remembered an old principle from systems theory that
I had read in the Whole Earth Catalog: "Energy flowing through a system
tends to organize that system."

That is why INREAL works for
everyone in the room. Protect the basic human connection of kindness, respect
and mutual interest in whatever is currently going on, protect the flow
of genuine communication, and anyone can communicate successfully with
anyone.

The hardest thing to remember, I think, is that genuine
communication cannot be developed "on purpose." No one can strategize or
coerce their way into genuine communication. Genuine communication is simply
shared joy -- not for sale anywhere at any price. There is only one intentional
act that can actually foster genuine communication, and that is to protect
the shared joy from being undermined by preconceived notions about what
"should" be happening.

Shared joy happens automatically when we give up aggression,
seduction, and prejudice. Not all, at once, usually, but gradually. It
can happen all at once, as in the Zen experience of satori -- sudden enlightenment.
But even someone who has had numerous satori experiences may find that
stabilizing the experience, learning to risk joy in all the different situations
we encounter, may take a long time.